Refokused Tax Solutions
Thank you for choosing our tax preparation services. Please complete the following form to provide us with the necessary information for your tax preparation.
Client Information
Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
Tax Information
Tax Preparer
Please Select
Arrington Hall
Debora Fuentes
Jamisha Lewis
Jonathon Jackson
Kenya Neal
Kimionte Bennett
Mauranda Williams
Nigeria Rushing
Olivia Landois
Precious Emery
Tyreon Brown
Tamara Bennett
Referral Name
Tax Year
2019
2020
2021
2022
2023
2024
2025
Filing Status
Single
Married Filing Jointly
Married Filing Separately
Head of Household
Qualifying Widow(er)
Income
W2 Employement
1099
Self Employment
Investments / Dividends
Rental Income
IP PIN ( if applicable )
Are you a full-time student? (Do you have your 1098-T form?):
Yes
No
Do you have a 1095-A Health Insurance Marketplace Statement?
*
Yes
No
Do you owe any tax obligations, student loans or child support? If so, how much?
*
$1-$5000
$5,000-$10,000
More than $10,000
No I do not owe any obligations that could garnish my tax return
Dependents
Dependents
Upload Your Social Securty Card
*
Browse Files
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Choose a file
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Upload Each Dependent Social Security Card
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Upload All Tax Documents (W2/1099/1095A/SS CARDS/ALL TAX DOCUMENTS)
*
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Upload Front of Drivers License/ID
*
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Upload Back of Drivers License/ID
*
Browse Files
Drag and drop files here
Choose a file
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How do you prefer to receive your Tax Refund?
Please Select
Direct deposit
Check
Green Dot Prepaid Visa Card
Routing Number
Account Number
Signature
*
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